Partygoers were not asked for solutions and the devil is always in the details, so let’s use my favorite – flu shots.

First, the New York Times reported that party participants quickly agreed that “…health care was a right…” It makes me wonder; if health care is a “right,” what of “responsibility”?

- If I have a “right” to flu shots to help prevent flu disease, do I have a “responsibility” to get them to protect myself, reduce my medical care costs, improve economic productivity and protect others around me?
- If I don’t get the shot, infect others and cause them to be ill, am I responsible for the cost of their care?
- If others I infect miss work, am I responsible for the cost of temporary workers or losses incurred by their employer? Am I responsible to the government for the loss in taxable productivity?
- What if they die as a result of the flu I transmit to them? Am I culpable?

Second, participants also agreed “…that insurance should cover ‘everything,’ not just some services….”
- If a flu shot is covered and I choose not to get one, should I be required to pay for any doctor visits and medicines I need?
- Should my employer have the right to charge me for the temporary help that might need to be hired to replace me on the job?
- Should Uncle Sam have the right to tax me for earnings I would have made if I had been on the job?
- Should the cost of something so reasonably priced be covered for everyone? Really, I mean everyone? Even the wealthy who can well afford the cost?

Third, participants agreed that “…coverage should be readily available from the government, as well as from employers….” They agreed that individuals and businesses should have to pay a “small health care tax” to fund care.
- Who are they kidding, “small health care tax?” Have they looked at cost projections lately?
- And what about non-coverage barriers? Coverage is only one barrier to care. Ask those in rural areas, anyone not fluent in English or medically literate.

And yes, I’m still harping on flu shots. The season is not nearly over and there are plenty of doses left to protect the nation from the $87.1 billion – or more – that flu could cost us this winter.¹

1. Molinari NA, Ortega-Sanchez IR, Messonnier ML. The annual impact of seasonal influenza in the US: Measuring disease burden and costs. Vaccine 2007;25:5086-5087.

President-elect Obama and Secretary of HHS designate, Tom Daschle, invited concerned Americans to discuss healthcare reform in community groups across the country. My husband and I hosted one such group at our home in DC yesterday. Although we had been instructed to compile a list of compelling stories about system failures – instead we decided to be rebellious and discuss “what’s right with the healthcare system” and compile a list of best practices to submit to the change.gov website.

The event was attended by a wide range of healthcare stakeholders, including a government relations expert, FDA manager, US Marine, patient advocate, health IT specialist, transportation lobbyist, real estate lobbyist, health technology innovator, Kaiser-trained family physician, medical blogger, and EMR consultant. Here is what they thought was “right” with the healthcare system:

1. Customer Service. Market forces drive competition for business, resulting in increased convenience and customized service. Healthcare consumerism has driven patient-centered innovations that improve quality of life. Examples include convenient walk-in clinics, online scheduling, services available in a one-stop location, and seamless transfer of health information (such as within the Kaiser Health system).

Memorable Quote: “We have a tremendous amount of choice in our system. That’s very good for patients and I hope we never lose it.”

2. Accommodations For People With Disabilities. Kaiser Permanente was cited as an organization that takes special interest in facilitating good patient experiences for vulnerable populations and people with disabilities. For example, extra time is allotted for travel to and from the clinic, and schedules are built with flexibility to accommodate mobility impairments.

Memorable Quote: “Kaiser trains all its staff to be sensitive to people with ethnic, racial, and sexual preference differences. They learn to listen to the patient, and never assume they know what they think or feel.”

3. Specialty Care. So long as a person has health insurance, access to the very best specialists in the world is available in a very democratic fashion to all patients. Several success stories included surgery and follow up for major multiple trauma, and congenital anomaly repair.

Memorable Quotes: “I’m only here today because of the technical skills of a U.S. surgeon who saved my life…” “I’ve traveled all over the world, and I wouldn’t want to get my medical care in any other country.”

4. Social Media. Internet-based tools and social media platforms are leveling the communication “playing field” between providers and patients. People are discussing their care and treatment options with others like them online, as well as socializing with physicians and receiving real-time input on health questions.

Memorable Quote: “On Twitter I have I.V. access to physicians. I asked a health question and within 10 minutes I had 6 physicians answer me.”

5. Access To Allied Health Professionals. Scheduling time with mid-level providers is easy, convenient, and effective. Patients enjoy the ability to access generalist care with nurse practitioners (for example) who provide quality care at a more relaxed pace.

Memorable Quote: “I love my nurse practitioner. She really listens to me and her schedule is much more flexible than physicians I’ve known.”

6. Drug Development For Rare Diseases. The U.S. government offers grants, extended patents, and exclusivity to drug companies willing to develop drugs for rare diseases. This dramatically improves the quality of life for patients who would otherwise have no treatment options.

Memorable Quote: “The FDA recently approved the first drug for Pompe’s disease. Only a few hundred patients in the U.S. have the disease, and yet this life-saving medication was developed for them thanks to government incentives.”

7. Patient Autonomy. The healthcare consumerism movement has replaced medical “paternalism” with care partnership. Patients are seen as consumers with choices and options who must take an active role in their health.

Memorable Quote: “Patient accountability is key to better health outcomes. But they need guidance and decision support… General health literacy is at a sixth grade level.”

8. Health Education. Technology has improved health education dramatically. Patient education about their disease or condition is often facilitated by demonstration of computer-based anatomic models.

Memorable Quote: “I think that doctors are getting much better at communicating with patients in ways they can understand.”

9. Coordination of Care. Some hospitals like the Mayo Clinic do an excellent job of coordinating care. For example, they provide each patient with photos and names of all the physicians, nurses, and specialists who are on their care team. Nurses update the patient’s schedule daily to reflect the tests and procedures anticipated and provide dignity and sense of orientation to the hospital experience.

Memorable Quote: “The Mayo Clinic has gone Facebook.”

10. Democratization of Information & Transparency. Patients have the right to view and maintain all their medical records. They have many PHR options, and may be provided with CDs or thumb drives of their personal radiologic information to take with them to their next provider. Many doctors write their notes with the understanding that the patient will be reading them.

Memorable Quote: “One day soon, hospital stays will no longer occur in a black box. Family members and friends will be invited by the patient to view their daily schedule online, while nurses update planned procedures, events, and meetings. Family members won’t miss the opportunity to meet with the patient’s care team, because it will be on the schedule. MyChart (from EPIC) is working on making this hospital experience a reality at the Mayo Clinic soon.”

***

Thanks so much to all of you who attended. My husband will be preparing a report for the transition team shortly.

_____

Dr. Val Jones, M.D., is the President and CEO of Better Health, PLLC. Most recently she was the Senior Medical Director of Revolution Health, a consumer health portal with over 120 million page views per month in its network. Prior to her work with Revolution Health, Dr. Jones served as the founding editor of Clinical Nutrition & Obesity, a peer-reviewed e-section of the online Medscape medical journal.

My Top 10 Priorities for the Next HHS Secretary (NOTE: this was written prior to the selection of Tom Daschle–not surprisingly, I was holding out hope for a woman–no offense to Mr. Daschle):

The next Secretary of the US Department of Health and Human Services (DHHS) will have a plate that is not only full, but is overflowing. While all the political rhetoric is focused around access—health insurance for all—there are a number of other critical areas that need immediate attention as well.

Clearly there are many more than 10 priority areas. However, if I just so happened to find myself sitting across from the next Secretary of HHS, I would remind her (just indulge me on that) that she is the Secretary of Health AND Human Services—that for her to make a dent on the health side of things, she must take into account whether people have: the support systems they need, heat, a home, transportation, enough to eat.

Here is my list of the top 10 priorities, in no particular order:

1. Human Services—In other words, just because someone finally has access to health care, it may not be enough. Madam Secretary: Please consider creating a new position: the Assistant Secretary of Human Services to oversee the coordination of services that will surely make a difference in the outcome of someone’s health: From a process systems standpoint, Does the patient have transportation to get to a health provider? Will that patient have a working refrigerator to store medications that require colder temperatures? Is the patient able to feed himself? To understand all the discharge instructions? Is the patient living in a clean, warm, place? You get the point.
2. Mental Illness—Columbine/VA Tech shootings; depression in epidemic proportions; what will it take to get us to improve services, coordinate care, and erase the stigma.
3. Research—It is unconscionable to not: pursue to the fullest extent possible, the promise of stem cell research; fully mine the treasures that genomics, proteomics, and personalized medicine hold within our reach; create incentives for researchers and innovators to focus on rare diseases; develop exciting competitions for young scientists; include with greater frequency children, minorities, the elderly, and women in ethically sound and appropriate trials—we get sick too, you know.
4. Electronic Health Records/IT—Enough already with the red flags. Privacy is critical—but it shouldn’t be the distraction we have allowed it to be—there are ways to address the privacy concerns (look at other sectors, look at legislation such as GINA, the Genetic Information Nondiscrimination Act of 2008, and look at the American Medical Informatics Association concept of data stewardship).
   And, while Congress is twisting itself in knots in the name of privacy, (which I agree is of critical importance), there are thousands of patients and caregivers, especially those battling life-threatening illnesses, who are putting all their personal information on the Internet—they believe that by engaging with others globally, treatments and cures could come about faster. Sites such as Patients Like Me are gaining traction.
5. Adolescent Health (binge drinking, unsafe sex, obesity, stress, body image)—I have an 18 year old son and a 14 year old daughter; I am here to tell you it’s a scary world out there for adolescents and their parents and guardians. It would be fantastic to see a full blown Public Awareness/Education Campaign that addresses underage and binge drinking—(these college presidents who want to lower the legal drinking age should be ashamed of themselves).
6. Disparities—It is a national disgrace that in 2008, “despite continued advances in health care and technology, racial and ethnic minorities continue to have more disease, disability, and premature death than non-minorities.” We can no longer afford to wait to correct this injustice.
7. Workforce—We have documented shortages of nurses, of primary care physicians and certain specialties. We have shortages of provides in rural areas. And yet, we still can’t figure out a way to all get along—how about a real integrated team approach where multiple providers work together for the good of the patient? For that to happen, Madame Secretary, it is imperative that you strive to maintain a diverse health care workforce. I know, I know, there are some models out there, but so far, not much real progress. I know, I know, reimbursment’s an issue—for that, please see priority #9.
8. Health Literacy—In April 2004, the Institute of Medicine released a report entitled Health Literacy: A Prescription to End Confusion which found that “Nearly half of all American adults—90 million people—have difficulty understanding and using health information, and there is a higher rate of hospitalization and use of emergency services among patients with limited health literacy…Limited health literacy may lead to billions of dollars in avoidable health care costs.” For more information, check out http://nnlm.gov/outreach/consumer/hlthlit.html.
9. It’s the Reimbursement, Stupid—(Not you, Madame Secretary, it’s just an expression). Until we figure out how to pay all providers fairly, equitably, and dare I say simply (this SGR business is for the birds), it will be challenging indeed to move the health care needle forward.
10. Patient-Centered Care—With all the policies, politics, and regulatory hurdles that come along with the job, please don’t loose sight of the fact that at the end of the day it is about people. People who are frightened, who are in pain, who need to know there is someone out there who they can depend on when they need it most.

Hubert Humphrey once said, “The moral test of government is how it treats those who are in the dawn of life—the children; those who are in the twilight of life—the aged; and those who are in the shadows of life—the sick, the needy and the handicapped.”

Looks like you’ve got your work cut out for you.

Jane Zhang of the WSJ reported:

The Congressional Budget Office analyzed 115 options to change health care, some costly and others that would save the government and consumers some money.
…
Among the findings:

- If no changes occur, CBO says health care spending will rise to 25% of GDP by 2025 from 16% last year.

- If the federal government required all employers with more than 50 workers to provide insurance or pay a penalty, federal revenue would increase by $13 billion in four years and $47 billion over nine years.

- Allowing non-federal workers and companies to buy into the Federal Employees Health Benefits Program would cost the federal government about $2 billion over four years and $6.2 billion over nine years.

Ezra Klein explained the importance of these reports and the impact they could have on healthcare reform plans:

How do we decide how much a government program costs? It’s an essential question. Programs need prices, because the government has to produce a budget. But pricing legislation in advance is impossible… But you still need a number. So Washington operates amidst a tacitly agreed-upon imprecision. What the CBO says, goes. “In this town,” says Henry Aaron, a senior economics fellow at the Brookings Institution, “it’s not infrequent to hear people say it doesn’t make any difference what it really costs. It only matters what CBO says it costs.”

The books that the CBO released this week are essentially a guide to the CBO’s scoring process. They tell congressmen, in advance, how the Number will be built. The Wonk Room and The New York Times are focusing on the equations. But they’re not what’s changed. Rather, the difference is that Congress knows what they’ll be in advance. The scoring process will still be a minefield, but now legislators will have a map. There won’t be a situation analogous to 1994, when the White House was shocked by an unwelcome assumption and their legislation was mortally wounded by a staggering price point. Obama and his allies in Congress, along with Orszag’s help, will be able to build a bill able to survive the scoring process. They can, effectively, decide their own Number.

Bob Laszewski, of the Health Care Policy and Marketplace Review blog, summarizes what he believes to be the documents’ critical conclusions:

- There are no one, two, or even ten silver bullets. There are literally dozens of steps that will likely have to be taken in order to achieve the savings necessary to make our system more cost and quality effective.

- The politically easy stuff won’t get it done. Democrats and Republicans have said that things like prevention, wellness, and wider use of health information technology can free-up the savings we need to make our system affordable even while we dramatically expand the number of citizens covered. But the CBO confirms that these less politically problematic “cost containment lite” proposals won’t be enough: “…approaches—such as the wider adoption of health information technology or greater use of preventive medical care—could improve people’s health but would probably generate either modest reductions in the overall costs of health care or increases in such spending within a 10-year budgetary window.”

- Really controlling costs will be very hard and will require some courageous and politically problematic actions: “Those problems cannot be solved without making major changes in the financing or provision of health insurance and health care. In considering such changes, policymakers face difficult trade-offs between the objectives of expanding insurance coverage and controlling both federal spending and total costs for health care.”

- Changing what we pay will have far more potential to change the system’s costs than changing how we pay.

On Managed Care Matters, Joseph Paduda challenges that an important component of the CBO health policy study findings must not be overlooked:

There’s a lot in the study that’s very good, but much of the discussion has missed a central point. There is enough money in the system today to pay for excellent care for every American - probably more than enough. While we can save $110 billion over ten years by negotiating a 15% rebate on drugs covered by Medicare Part D and another $34 billion from efficiencies resulting from improved health care IT, these totals are chump change next to the amount of money we waste by delivering too much care to people who don’t need it.

…

The CBO report suffers from a troubling omission - an explicit acknowledgment of the impact of over-utilization on US health care costs. While the authors provide an excellent analysis of a hundred-plus health reform initiatives, they do not address the elephant in the room - too many doctors prescribing too many treatments that have no basis in science, no demonstrated efficacy, deliver no benefit to the patient.

That’s where the money is. Yet the CBO study claims that savings from comparative effectiveness research would be tiny - and most of the benefit would take place more than ten years in the future. Where the study misses the mark is in assuming that the health care funding, regulatory, and delivery systems remain static. Without fundamental change, their numbers are likely correct, and may well be optimistic. That, I would suggest, is the point.

And, over at The Wonk Room, Igor Volsky reminds us that the conversation cannot only be focused on cost-savings measures:

After all, that’s what the government does: it spends money to avert disaster. We spend billions on protecting our homeland and bailouts of financial institutions. To somehow change the paradigm in the health care discussion and argue that reform is only possible if it’s budget neutral, completely affordable, or free, is intellectually dishonest. We don’t count the pennies we spend on securing our airports or argue that if we try to secure all of them we’ll bust the budget, and we shouldn’t penny pinch for affordable health care.

As the CBO points out, certain cost-containment measures will indeed contain costs. But to avert the consequences of inaction and help its citizens, the government will have to invest new dollars into health care. As with anything else, it will have to collect taxpayer money, find savings where it can, and then spend to improve the common good.

The consensus from the bloggers highlighted here and others from around the blogosphere is that the Congressional Budget Office is to be commended on publishing two accurate, insightful reports, but what is yet to be determined is what will come next and how the CBO findings will be reflected in the policies of this next administration.

“(Much long-term care is provided personally by the family and friends of elderly and disabled individuals.)”

Earlier in the chapter, CBO points out that patient/family out-of-pocket spending accounted for 20% of the total long term care spending. While one-fifth of spending is a lot, I think it probably underestimates the full value of direct care provided by the family, purchases of needed non-prescription and non-reimbursed medical equipment and supplies, and lost income by the caregiving family members.

CBO does make some oblique references to the magnitude of unaccounted-for care in its discussion of the pros and cons of adding home-based care incentives to Medicaid—the dreaded “out of the woodwork” factor—the number of people they cannot count who might come forward for services and wreck federal-state budgets.

Over the last few years, despite a restrictive prospective payment system, home health services for seniors eligible for Medicare has increased so rapidly that CBO and MedPAC both recommended reigning in spending by reducing rate updates and—to my horror—a suggested co-payment of 10%. CBO says:

“An argument in favor of this option [co-payment] is that it would directly offset a portion of Medicare’s home health outlays and encourage beneficiaries to use those services in a cost-conscious manner.”

I wonder if these analysts have ever used home health services for their needy family members. Caregiving for people with chronic health conditions is a round-the-clock commitment. The home health benefit under Medicare provides a measly couple of hours per day, a few days per week. We are already contributing way more than 10% to the home care of the beneficiary, and I can assure CBO that we do so in an extremely “cost-conscious manner” since we pay at least 20% of long term care services out-of-pocket—didn’t the analysts read ahead to Chapter 10?

When it comes out of your own pocket, you make every penny count, and you make the best use of services—like the home health nurse, aides, therapists—to maintain the independence and dignity of the family member you’re caring for, and to give the caregiver much needed support, information, and relief.

There’s some teeth-gnashing in the report about the low enrollment rate in long term care insurance policies. One of the reasons is the high cost of the premiums in relation to the daily benefits. If you have a chronic condition, you’re unlikely to qualify, or the premium is beyond reach. If you’re a caregiver, chances are you don’t have a lot of leeway in your budget to purchase a policy. I’m not convinced that the alternatives offered in this report will help much.

All-in-all, I was disappointed to see that the options listed in the appendix were organized by stakeholders but did not include a cross-reference by patient or caregiver.

The report is discussed on the CBO director’s blog at: http://cboblog.cbo.gov/?p=193.

What do you think? Share your opinions by responding to our poll:

Meanwhile, four issues dominating discussions around the web this week are the future of the FDA, the new Nursing Home Compare rating system and web site, physicians and health IT, and of course, healthcare reform issues.

At the Center for Medicine in the Public Interest DrugWonks blog, Peter Pitts shared his recommendations for reforming the Food and Drug Administration:

I was honored when the Obama FDA transition team called and asked for my advice on how the incoming administration could make the agency a more robust and forward-looking regulatory instrument.
…
My suggested areas of focus are

1. A strong, science-based FDA
2. The Reagan/Udall Foundation — a Partnership of Unequals
3. Clarity vs. Ambiguity
4. Information Management
5. Food Safety and Security
6. Risk Communications
7. The Drug Label and the “Safe Use” of Drugs

…
There are, obviously, many, many other important issues … and I look forward to working with the transition team to ensure that the new commissioner can hit the ground running… And kudos to the Obama transition team for reaching out to a wide variety of groups.

On his Pharmalot blog, Ed Silverman wrote about a coalition of health groups that just “joined the heated lobbying battle over the next FDA commish” with a letter to HHS Secretary nominee Tom Daschle advocating for “a person familiar with the industry”:

The newly formed FDA Commissioner Coalition is made up of 34 patient and research organizations, most of which receive funding from drugmakers, the paper writes. The coalition’s letter to Daschle didn’t name any candidates but argues the next commissioner should make decisions free from “pressure from elected and appointed officials and from the news media.”

The move comes after weeks of speculation that the list of potential nominees… [who] have been outspoken in criticizing drugmakers over various products and practices.
…
In contrast to such public profiles, the coalition’s letter says relationships with industry should be viewed as a “positive qualification” for candidates, not as a black mark. A spokesman for Friends of Cancer Research, which signed the letter, says the coalition wants to reflect concerns of its members and didn’t coordinate its statements with drugmakers.

Jane Akre outlined some reactions to the new Nursing Home Compare system that the Centers for Medicare and Medicaid Services (CMS) launched on Thursday:

We use the five-star rating system when choosing a hotel — why not a nursing home? That’s the theory behind a new rating system proposed by the Centers for Medicare and Medicaid Services.
…
“From a consumer viewpoint, it’s not stringent enough,” says Alice Hedt, executive director of the National Citizens’ Coalition for Nursing Home Reform… The National Association of State Long-Term Care Ombudsman Programs (NASOP), a nonprofit comprised of ombudsmen representing their state programs, commends the new system. “We are very supportive of giving consumers information to select a nursing home and to monitor the home’s performance,” said Beverley Laubert, the association president in a statement. “And we urge consumers and their families to seek an understanding of how the ratings are derived and to use the ratings in conjunction with other resources.”

On the Covering Health blog, Pia Christiansen overviewed the new system further:

The ratings system is intended to be easier for consumers to use, as well as incorporating more data that has not been used in the past. According to The Bakersfield Californian, “The new rating tool will use federal data to score each facility’s performance in three areas: health inspections, staffing and quality measures.”

On his Musings on Aging blog, Anthony Cirillo had high praise for the five-star system:

The rating system is based on information from the last three years of surveys and complaints, staffing information collected at survey and quality measures. It is one more tool to use to assess care.

It is anticipated that approximately 20 percent of the facilities will receive five stars, 70 percent will have two, three or four stars and the remaining 10 percent will be assigned the lowest rating of one star.
…
Keep in mind that nursing home care is something we don’t like to think about and don’t want. But some of us WILL need it… So better prepared than sorry. Do your homework now for future reference.

On the WSJ Health Blog, Sarah Rubenstein covered a development for primary care physicians this week:

These days, the name of the game for getting government money is arguing that your well-being is vital to the nation’s economic recovery. Enter primary care doctors, hat in hand.

American College of Physicians President Jeffrey Harris sent a letter yesterday to HHS nominee Tom Daschle asking that the Obama administration’s economic-stimulus package include a 10% pay bonus for all services provided by primary care docs under Medicare for a period of 18 months. The letter also requests that primary care practices, especially small ones, get a piece of the funding pie for health information technology. Obama has pledged to spend billions of dollars on that endeavor.
…
Harris also alludes to problems patients have had getting appointments with primary-care doctors in Massachusetts, which has put in place a universal health-coverage plan. “Providing more people with health coverage doesn’t mean they will have good access to care, when there aren’t enough primary care doctors to take care of them,” he writes.

At The Health Care Blog, David Kibbe and Brian Klepper expressed their concerns and hopes for any health IT spending included in the Obama Administration economic stimulus package:

Whether the health IT money is well spent will depend on how it is distributed and what it buys. Most observers suppose that federal health IT investment dollars will be used to help doctors’ offices and hospitals acquire and implement electronic health record systems (EHRs or EMRs)… We agree that some of the federal health IT money should go to purchase EHRs, especially to doctors and hospitals in rural and under-served areas, which otherwise could not afford them.

The easy solution would be to spend most of the health IT funds on EHRs… But the easy solution would not be the right one… important as EHRs are, at this point there are far better ways to invest in health IT for the doctor’s office and hospital.
…
We believe that the Obama administration could leverage IT spending in similarly inexpensive ways. Smaller, incremental steps would likely impact a larger number of medical practices in the short-term, benefiting patients while limiting the disruption to doctors. Here are three suggestions:

1. Referral Management.
   …
2. Patient Communications.
   …
3. Infrastructure Build-Up and Maintenance.

(Check out the complete post for more details on these three suggestions.)

Commenting on the ongoing healthcare reform debate in and out of Congress, Ezra Klein noted:

If you’re looking for the coming fault line on the left of health care politics, keep an eye on what happens to the public insurance option in the health reform bill. Access to a public insurer is a big deal for progressives and conservatives alike. It’s important to progressives because they believe a public insurer — which is to say, an insurer that’s not concerned with the profit motive — could offer better coverage at lower cost, and in doing, attract more customers and pave the way to something closer to a single payer system. It’s important to conservatives for the exact same reason. The only difference is that progressives think this a very good thing that cannot be sacrificed while conservatives think this a very bad thing that cannot be allowed.

On that note, at The New Atlantis: Diagnosis blog, James Capretta commented on the upcoming “battle… fought over the so-called ‘public insurance option’” for which the Obama campaign advocated:

Many Democrats, including Senate Finance Committee Chairman Max Baucus, want to give workers the option to enroll in a public insurance plan modeled on Medicare. Proponents of this idea say they only want a fair competition with private insurance offerings, but the reality is that a public insurance plan would open a backdoor to a single-payer system. Public insurance plans always set fees for services well below market rates and thus shift costs to other payers who must negotiate, not dictate, rates with doctors and hospitals.
…
Some more moderate advocates of Democratic-leaning reform try to downplay the significance of the public insurance option, suggesting it might be discarded to get a deal. Perhaps. But the Obama framework really doesn’t work without it either because the Democratic approach to reform is entirely dependent on governmental price controls to hold spending in down. Jettisoning the public insurance option, absent a real marketplace, would drive the costs of Obamacare even higher.

Also looking ahead at 2009 healthcare legislation possibilities, Joseph Paduda warned against “inflated expectations”:

I’ve been rather negative about the chances we’ll see major health care reform next year. That doesn’t mean the new Congress and President won’t address significant issues — expect major efforts to change physician reimbursement, enable HHS Sec-to-be Daschle to negotiate with big pharma, slash the Medicare Advantage subsidy, invest in Health IT and expand SCHIP coverage. These are really really big issues…

We’re moving in the right direction, there is significant momentum, and focus is on the right areas. What we don’t need is a pell-mell rush to pass universal coverage and worry about costs later.

There’s an old adage — if you don’t have time to do it right in the first place, what makes you think you’ll have time to fix it later? If we screw it up on the front end, we’ll have zero political capital to clean up our mess.

Finally, getting into (one part of) the spirit of the season on the Let’s Talk Health Care blog, Charlie Baker asks (and answers), “what could health care and [the Bowl Championship Series] possibly have in common?”:

This year, when there are still two undefeated teams, and a host of teams with one loss (most of which occurred against one another), the idea of a two-team showdown based on computational statistics seems simply nuts. But the keepers of the BCS flame have their reasons for retaining the status quo, and they have the power and the juice to keep things just the way they are. Their rationale — to anyone looking at this from the outside in — seems pretty skimpy… the folks who participate in and benefit from the current arrangement don’t want to change it, and as long as the fans, the alumni, the TV networks, and the schools themselves continue to show up and participate every year, moving away from the status quo is simply not going to happen.

Which brings me to health care. Anyone looking at health care from the outside in would have to conclude that it needs to be reformed. And the commentary from the various analysts, experts and overseers on this question is quite familiar… And yet here we are, twenty years or so into this conversation, and it still works under more or less the same terms it’s always worked under. Why? Well, in some ways, it’s a lot like the BCS. As long as everyone who pays for, manages and participates in the current system likes it better than something they either don’t know or don’t understand, it’s unlikely that major change will occur.

Maybe major health care reform will happen at about the same time [as] Divisin I college football… Seems if we can do one, we can simply apply the lessons learned from that to do the other.

But the staff said that he was not yet “actively dying” and there was little (no?) need for him to remain on the inpatient hospice. Yet seeing the sad and fearful look in his eyes, the physician quietly mentioned that perhaps he could remain on the unit one more night. So he stayed another night and then we finalized the plans and arrangements for him to go home with round the clock home health aides.

And we came to learn that “actively dying” is used to describe the final phase of life and is/can be talked about or measured in terms like months, weeks, days or hours. Since dad was not “actively dying” it also meant that dad was not meeting acute hospice care guidelines.

So we also learned that even at the end of life, dad faced definitional and coverage issues that required us to navigate through the complex maze of payment/coverage challenges. We struggled to understand what was provided/covered by hospice; what was provided/covered by regular Medicare and what dad was responsible for. We faced decisions such as trying to locate a podiatrist who might make house calls (because palliative care physicians “don’t” cut diabetic patient’s nails)–(we never did find one); we searched for reliable, caring, and certified home health aides (because hospice “only provides/covers” a limited number of hours of home health care/day); and we filled prescriptions for certain medications (because some of the meds were for conditions not related to his terminal condition).

And in the end we couldn’t make any more sense of it than before.

But what really is comparative effectiveness? Comparative effectiveness in the context of health is as old as “medicine itself”, an implicit and explicit comparison of one medical technique to another. If the intervention works (i.e., understanding positive and negative impacts on patient outcomes), than one may translate this into “economic effectiveness”, or “cost-effectiveness” metrics. In our quest to assess value of medical interventions based on meaningful clinical outcomes, decision makers are using a number of well-established academic methodological approaches.

Is this new? No.

Through the years, research techniques, programs and processes have been employed evaluating health quality, benefits, costs and risks. Familiar approaches include “outcomes research”, health economics studies, evidence-based medicine (EBM), disease management, randomized clinical outcomes studies, evidence-based practice centers, technology assessments, and the like. Comparative evaluations of medical interventions is a well-established science with universities, global governments (including our own MedCAC and AHRQ), hospitals, pharmacy benefit managers and many other assessment think tanks employing the same approach but under different titles.

So how is the new proposal for a comparative effectiveness, independent government entity going to be different, better, or more comprehensive than any of the processes, programs and studies that medical technology currently undergoes? Will another process to examine technology beyond what currently exists provide the solution to unbridled health care spending?

Is it truly possible that investors or manufacturers of new innovations don’t consider the impact on patient benefit and costs before investing millions in commercialization?

Given the wide-spread use of assessment processes already employed, the comparative effectiveness initiatives proposed could be a tremendous benefit to manufacturers, physicians, and policy decision makers.

One hopes that the new government comparative effectiveness institute is fully funded to support the wide-array of comprehensive studies required to do this right. It is essential to continue to gather information comparing interventions paying only for those “worth the money”.

But without a serious fix of the payment systems that drive the use of new innovations (e.g., physician payment reform, rewarding acute care services over home, personalized, or preventative care), policy makers will have failed again at “saving money”.

To truly make an impact on health care costs, comparative effectiveness research must be the first step and complimentary effort to the vexing and impactful issues that truly have an enormous impact on spiraling costs but are more difficult and politically unpopular to solve.

At the National Journal Lost In Transition blog, Mary Gilbert explained:

Daschle, in his new dual role, will be responsible not only for crafting a health care plan but also for implementing it. Calling him “one of America’s foremost health care experts,” Obama claimed that Daschle’s knowledge of health care policy and extensive legislative experience make him uniquely suited to steer an effective reform package through Congress. As “the original no-drama guy,” Obama said, Daschle is also someone who can be trusted to use the HHS Department to implement the new policy on the ground.
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Pressed by a reporter on how he plans to pay for an overhaul of the health care system, Obama spoke about first cutting costs and then finding ways to make the system pay for itself over the long run, though he was short on specifics. He stressed, however, that fixing health care must be “intimately woven” into his team’s overall economic recovery plan. “We can’t put this off because we’re in an emergency,” he said. “This is part of the emergency.”

From Sarah Rubenstein on the WSJ Health Blog:

For his part, Daschle, who will also head up a new White House office dedicated to health reform, emphasized that this won’t happen behind close doors. (See our post from earlier today.) “We’re going to bring the American people into this conversation and make health-care reform an open and inclusive process that goes from the grassroots up.”

Says Greg Sargent at TPM Election Central:

Advocates had been awaiting a clear statement that Obama views health care reform as key to fixing the economy, a key talking point of reformers, and now they got one.

Paul Testa at The New Health Dialogue blog agrees:

The dual role guarantees that health reform will stay in the spotlight for the new administration.
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In both their remarks, Obama and Daschle stressed that restoring our nation’s economy requires reforming the health care system.

So did Ezra Klein:

The Obama presser on Tom Daschle and health care was promising. The first big signal concerned scheduling. “The time has come – this year, in this new Administration – to modernize our health care system for the twenty-first century; to reduce costs for families and businesses; and to finally provide affordable, accessible health care for every American.” Key words: “This year.”
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But won’t it be too expensive? On this question, Obama’s answer was positively Orszagian.. “Some ask how, at this economic moment, can we afford the challenge of reforming our economic system. I ask a different question. How can we afford not to?” That’s not only good rhetoric. It’s empirically accurate. “If we are to overcome our economic challenges,” Obama continued, “we must finally overcome our health care challenges.”

On The American Spectator AmSpecBlog, Philip Klein discusses highlights from Daschle’s book and the “Obama-Daschle proposal” that will come sometime in the next few months:

In his book, Daschle discusses the unraveling of the Clinton health care push in 1993-94 in great detail, and will try to learn from the mistakes that were made at the time. By having him lead the health care effort (somebody with vast experience moving legislation through Congress) Democrats will already be a step ahead of where they were with Hillary Clinton in 1993. He realizes that he’ll have to involve members of Congress in the process, rather than huddling in secrecy, coming out with a plan, and telling Congress how it’s gonna be. He also recognizes that one of the major problems with the original bill was that it was so long and detailed, that it was too complicated to explain to the public, and easy to pick apart by opponents.

Finally, at The Plank, Jonathan Cohn had high praise for Jeanne Lambrew:

One more note: I mentioned briefly, below, the significance of Jeanne Lambrew’s appointment. But it goes beyond the fact that she happens to know a heck of a lot about health care. She, too, has a strong commitment to what you might call the “social justice” side of the debate: Making sure everyobdy has insurance and, more important, good insurance. She also focuses heavily on issues like prevention and public health–which get less attention than simply extending insurance to everybody but may, in the long run, be more important when it comes to actually making all Americans healthy.

To launch our new poll, we are asking for your feedback:

But wait! There’s more!

The video response from former Senator (and head of the Obama healthcare transition team, at least until his HHS nomination is announced) Tom Daschle and Laura Arnonson (Obama healthcare policy team member) regarding the healthcare discussion generated over 4,400 comments since Tuesday afternoon — and counting!

Open, extensive conversations about healthcare issues and policy ideas are obviously very near and dear to our heart here at Disruptive Women. But what impact, if any, do you think the Change.gov approach will have on healthcare reform? What are your reactions to Daschle and Aronson’s video response to the blog comment discussion?

Here’s the video from Daschle and Aronson:

Over on his Washington Monthly Political Animal blog, Steve Benen noted the historical significance of the Change.gov blog, even though “the idea of setting up a website and accepting public comments doesn’t sound especially revolutionary” at first glance:

Historically, government-related sites have avoided public comments. The medium was about one-way communication, not two. To this extent, we’re already seeing the beginnings of a significant shift. George W. Bush ran an operation that stifled dissent and kept opposing viewpoints as far away from policy makers as possible.

On the ZDNet Healthcare blog, Dana Blankenhorn considered how the President-Elect’s effort “to drive the health care debate, from the bottom up” might affect the health care reform process, especially considering “how policy debates typically play out”:

Interest groups lay down markers, then go into small meetings and hash something out, which goes to Congress in order to die. The question is whether the Internet will be allowed to break through this.
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The question is whether ordinary citizens who are not inclined to support the new Administration will participate, or whether they will rely on top-down organizations to oppose it.

On Covering Health, Ed Silverman reacted to the blog discussion and video response from Daschle and Arnonson, which, he explained, reviewed “a couple of key issues and the overall response to their effort”:

To be candid, there wasn’t much said that we don’t already know. Daschle, at various turns, says things such as, “We need to really put the emphasis on prevention” and later, “We need to contain costs.” To be fair, the willingness to engage the public in this way is worth noting. After all, when was the last time that HHS Secretary Mike Leavitt deliberately spoke to Americans by way of YouTube? Send us a clip if you have one. Meanwhile, Daschle promises more online discussions are forthcoming.

On his LibertyAir blog, Liberty Advocate expressed similarly mixed (but still optimistic) reactions:

Currently we have a president who has overt contempt for public opinion, who shields himself from opposing views and whose idea of White House Web site interactivity is a video of his dog. Barack Obama has a chance to take governing to a whole new height. Currently the Obama transition team is actually soliciting public comments on its Web site, reading them and responding to them.
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It’s early and it’s entirely possible that a Barack Obama administration will simply use the Internet as a glorified marketing device. But what’s happening on Change.gov could be the beginning of a true national conversation.

(See also: “It’s time for a Wiki White House” by Dan Froomkin, at Nieman Watchdog.)

At the techPresident, in her Personal Democracy Forum Daily Digest, Nancy Scola highlighted all aspects of Daschle’s interactive strategy, which, as she explains “isn’t necessarily limited to the web”:

The Washington Post’s Ceci Connolly has a fascinating look at how the former senator from South Dakota is hosting a closed conference call with a thousand supporters culled from 10,000 with an interest in health care. And the HHS appointee is also promising to hold live town halls on health policy. Health care reform in the United States won’t happen without a fight, and it’s fascinating to watch Daschle recognize the need to mobilize the public behind what promises to be an epic battle.

Today, Daschle is discussing another interesting element of the incoming Administration’s plan for reforming health care as part of a speech in Denver, Victoria Knight reports on the WSJ Health Blog:

Daschle wants Americans to host “holiday-season house parties to brainstorm over how best to overhaul the U.S. health-care system,” the WSJ reports. He’ll make the suggestion as part of his case for health reform in a speech to be delivered in Denver today. He plans to drop by one health-themed party this season and take some of the ideas back to Obama, so get the low-fat eggnog and universal-coverage cheer ready.

I sometimes see genetics as a leading edge, a knife that is cutting through the old, crusty, barriers.  It does this perhaps because it is new, but after leading with the novel edge, it has a great deal more punch.  I believe it will be an innovative disruption (a la Clay Christensen) because the health care system will not be able to adjust enough to fit its value inside the system (or lack thereof).

Starting with the power of understanding family history (still perhaps the most powerful genetics tool) to the sophistication of personalized medicine (using genetics and genomics to tailor diagnosis and treatment), genetics and genomics will both buoy and stress an overstressed healthcare system.  It is time for change.  It is in the works, on the drawing tables and in people’s hearts and minds.

Genetics is about both difference and sameness.  We are fond of saying we are 99.9% the same as the next person (and 50% the same as a banana:-).  And we are excited about the fact that our genome can make the difference for us when it comes to how we metabolize a medication, or what treatment is best for an individual.  That duality is one that western civilization is not normally comfortable with – it is something that challenges us to understand both public health and individual health in the same breath.  Literally.

I believe genetics offers us a new paradigm on a number of levels.  Certainly the science is ready to take us to new places.  But I recommend we ponder what it means to balance the collective and the individual needs in health services, privacy, research and public health.  I think if we begin to see these not as two sides of a coin, or as a dichotomy, but as yin yang, we will have a basis for a transformational system that will focus on prevention, and obliterate disparities.

I had a tangible experience of this during the week.  My daughter Elizabeth turns 21 on December 12th.  She, and my son, have put up with a great deal of my time being focused on not only the 3,000 or so people that have the condition they do - pseudoxanthoma elasticum (PXE) - but on the 25 million or so individuals with genetic conditions. Elizabeth cam to me this weekend and asked if she could put up a donation page for support for PXE International.  The page is an example of the balance of both personal and global participation in health, community and life.  http://www.firstgiving.com/elizabethterry

I believe we are building a community, and I am delighted to be a part of it, here and elsewhere.  Where do you see boundaries dissolving?  Where do you see the tensions in public and personal health, in inequities in the system?  Let’s solve this together - lay it out, so we can all participate!

I recently moved and so cancelled my usual vacation to unpack boxes and get settled. I’ll vacation later. The move delayed more than vacation, however. It also delayed my getting a flu shot, I’m still inside the “window” during which I may not yet be protected by the vaccine and I know that few people I meet are likely to be immunized and therefore any “herd immunity” I might count on to stay healthy is not there either. Sunday afternoon arrived with a feeling I dread….”like maybe I was coming down with something.”

It brought back memories of the first Thanksgiving I learned to cook a turkey. I was ten, my Mom got the flu. Not the just-don’t-feel-good flu we all mistakenly call every winter symptom, but the for-real-very-sick-can’t-lift-her-head-off-the-pillow influenza. Step by step, she talked me through how to make the dressing, stuff the bird and cook it.

That experience showed me what flu can do to a person. Since then my public health experience showed me what it can do to a nation. As a result, I’m an enthusiastic promoter of flu – and other – vaccines.

I’ve contemplated this even more lately, as for the first time our nation will produce nearly twice as many flu doses as we have ever administered. Public health officials asked for the increase and companies made it happen. CDC said “make it and we’ll use it.” Companies said “use it and we’ll make it.” Well, the companies have called our bluff. Will we use it – or not?

It remains to be seen. I wrote last month about the economic value of health, hoped you’d visit the lecture at www.ted.com/index.php/talks/view/id/92, explore the data in greater depth at www.gapminder.org, and get a flu shot.

Since then, Bailout costs continue to soar and now more than ever we need to be a healthy and productive nation. We cannot afford the economic burden of flu $87.1 billion – or more – that flu could cost us this winter.¹

But the burdens are not just national and that is the point of this blog. It’s personal. I woke up feeling better this morning, will have a busy day and tomorrow leave for Washington and then Chicago to facilitate meetings. Since I’m healthy, clients won’t have to scramble for replacement facilitators, I’ll be there to do the job and by the way – I’ll be paid.

In a recent speech I said I valued my own health for a variety of reasons, not the least of which is my own personal ability to generate income. Economists can chart the relationship between health and wealth for nations. Their data looks valid, but feels impersonal. As a self-employed person, I feel that relationship very directly, very personally.

The economic returns of productive work (vs 10 days influenza illness) and (on the softer side) time with friends and family, add to far more than the $20 most of us will pay for a flu shot. In that speech I valued a flu shot at $1,000 to me. In these tough economic times it’s tempting to lower the value and say it’s only worth $500 perhaps… but then in tough economic times, prevention is all the more valuable and perhaps even more than $1,000 might be a great deal. What do you think?

References
1. Molinari NA, Ortega-Sanchez IR, Messonnier ML. The annual impact of seasonal influenza in the US: Measuring disease burden and costs. Vaccine 2007;25:5086-5087.

There has been a great deal of buzz over President-Elect Obama’s choice of Melody Barnes for Director of the White House Domestic Policy Council, as ThinkProgress reported Monday. (You can also check out the official Obama-Biden Transition Team blog post.) Before taking an advisory role on Obama’s transition team and campaign, Barnes held the position of Executive Vice President for Policy at the Center for American Progress. Also, from 1995 to 2003, Barnes served as chief counsel to Senator Ted Kennedy. Many have suggested that Barnes’ primary focus in the new Administration will be on health care policy, given her record on health care issues and the President-Elect’s stated domestic agenda priorities. Noting Barnes’ record at CAP, Ezra Klein wrote:

Barnes has been one of the chief architects of CAP’s domestic policy program, and in that, she’s created a formidable and decidedly impressive organization.

At The Field, Al Giordano commented on Barnes’ record as an “unabashed progressive,” and on what her role in the Obama Administration will include:

Barnes will coordinate the mega-board of the Cabinet secretaries of Health and Human Services, Justice, Labor, Education, Housing and Urban Development, Commerce, Energy, Treasury, Agriculture, Transportation, Interior and Veterans Affairs. Basically, she’ll be domestic policy czar.
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1993. Want to get an idea of how progressive she is? Read this: In January of 2007, prior to President Bush’s state of the union address, Barnes wrote this essay for the Washington Post, What a Progressive President Might Say…

(Read Barnes’ essay here.)

On the RHRealityCheck.org blog, Todd Heywood highlighted Barnes’ understanding of the “connections between health and economy”:

During the presidential campaign, I had an opportunity to have a one-on-one with Barnes during which she talked at length about the importance of addressing the HIV/AIDS epidemic as a key to addressing urban renewal programs.
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By appointing policy leaders like Barnes who see the connections between health and the economy, Obama appears to have pulled together an economic team that reflects many of the goals he set out during his campaign.

Over on her shakesville blog, Melissa McEwan contrasted Barnes with her soon-to-be-predecessor:

The current Director of the White House Domestic Policy Council for President Bush is Karl Zinsmeister, not just your run-of-the-mill straight white conservative dude, but a patently unqualified and unethical straight white conservative dude who’s contemptuous of the very position he’s being paid to fill. Change I can believe in: An eminently qualified and authentically progressive woman of color managing domestic policy.

On the other hand, “A Catholic View” blog expressed concern over the choice of Melanie Barnes, reflecting Catholic League president Bill Donohue’s views:

Bill Donohue is concerned about Barry’s latest pick. The rest of us Catholics should be also. It seems that her specialty is dissenters.

In other transition team news, President-Elect Obama is planning to nominate Congressional Budget Office (CBO) Director Peter Orszag to lead the Office of Management and Budget (OMB). Reacting to the news, AARP commented, “President-elect Obama’s selection of Peter Orszag is great news for anyone who cares about fixing our broken health care system.” Many have echoed this sentiment.

Ezra Klein praised Orszag’s influence on health care policy as CBO director:

If you’re interested in health care reform, the appointment of Peter Orszag to be director of the Office of Management and Budget is second only in importance to the the elevation of Tom Daschle to health czar and HHS secretary.
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[At CBO], he’s shown an almost single-minded focus on health care reform. He’s added dozens of health care analysts to the staff, reconstructed the health policy division’s management structure, and is readying to release two major books on health policy options and CBO’s health care scoring models… Amidst all that, he’s toured the country giving a slide show about the problems of the health care system, the overwhelming danger it poses to our fiscal condition, the incredible inefficiencies that beset the delivery, and the research that suggests reform could not only save money but also improve care. He’s also acted as a powerful and credible counterweight to those who counsel incrementalism, or delay, on health reform. Indeed, when it became common to suggest that the bank bailout should displace ambitious agenda items like health care reform, Orszag took to his blog — yes, he has a blog, did I mention that? …

(Check out Orszag’s CBO Director’s Blog.)

Similarly, on Daily Kos, DemFromCT added the Orszag choice “to our previous list of signs and portents that Obama is taking health care reform seriously and in a big way,” remarking that “with Orszag at OMB, maybe” important health care initiatives will even “be properly funded.”

Although these developments may indicate real action on health care reform under the new Administration, some have expressed more cautious praise of the President-Elect’s choices so far.

Chris Bowers was pleased with the senior advisors “in the progressive mold” who Obama has selected so far, including Melody Barnes, but he also commented:

While it is a decent progressive start to filling out the White House senior staff, one question that remains to be seen is if these senior staff appointments really are the equivalent, in terms of power, to the cabinet appointments that so far have unanimously gone to centrists. I have heard from sources that I trust that this absolutely is the case, but the lack of progressivism within the cabinet leaves me feeling wary. It seems important to me to have progressive voices in both areas, given that with Rahm Emanuel and Lawrence Summers, it is hardly the case that White House senior staff will be dominated by progressives. Minority representation in the White House senior staff, and no representation in the various cabinet departments, is simply not adequate.
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the important posts to watch from here on out will be Assistant Secretaries for Policy in the various cabinet departments. That makes sense, because even a cabinet secretary has to delegate a lot of authority, and those positions in each department will be the ones focused directly on policy. That is where we can make policy progressive, and so those are the posts that we need now. Given that there is a fairly decent mix of progressives in the White House senior staff, if we can also get the departmental policy directors, then progressives will have representation in most areas. But we need those positions before I start to relax on this front.

What about you? How will President-Elect Obama’s staff selection affect your life?

I told the interpreter that I wanted to share a story with her. A long time ago I had an assistant who I was very fond of, and she, me. One day an elderly Jewish lady, whom I’ll call Mrs. Goldstein, had an appoinment to purchase hearing aids. When she left without purchasing them, Katie, my assistant, asked “did Mrs. Goldstein try to Jew you down on the price?” What was so upsetting to me was that she had absolutely no idea that what she was saying was offensive, bigoted, insulting and just plain ignorant. I explained that to Katie and vowed to myself that I would help teach her the truth…it is the only way to combat prejudice.

I asked my staff person to help me in the same way. I am not an audist…but I may occasionally say things that might make it seem, out of ignorance that I am. Rather than make derogatory comments I asked her to take the time to educate me. I am very open to listening and learning.

At the final GAIN analysis workshop earlier this month, we were given the chance to review data generated over the last two years, including disease studies of psoriasis, depression, schizophrenia, diabetic nephropathy, and bipolar disorder. It was exciting to see that each study identified important regions of the genome associated with these diseases. Unfortunately we also learned that neuropsychiatric diseases remain a challenge as the search for genetic variation and diseases is hampered by the complexity of the phenotypes involved, as well as the apparent diversity in genes which contribute to the diseases.

Following the workshop, I spent several days with my Helicos colleagues at the American Society of Human Genetics (ASHG) annual meeting, which brought together over 5,000 scientists from across the globe. The event has come a long way from ten years ago when a major focus of this important meeting was rare genetic diseases. Now, we have seen the foundation of these rare disease studies applied to the study of more common diseases, as evidenced by work in GAIN.

Many studies, including cardiovascular disease, diabetes, and inflammatory diseases, were presented at the whole genome level, revealing new insight into genes or gene regions involved in these diseases. Still though, these studies involve the investigation of the common alleles which appear at relatively high frequencies in the population. As we continue to study the human genome, we are recognizing the amazing heterogeneity contained within our genomes. It was this new knowledge that drew me to my current role at Helicos BioSciences.

Three human genomes were also presented (AML patient, Craig Venter and an Asian individual), highlighting again that the genome contains many more single nucleotide variants than expected. In addition, new knowledge on structural variation underscores the importance of insertions and deletions as well as copy number variations within each genome.

Equally exciting are the emerging technologies to allow an assessment of the human genome – including Helicos’ Single Molecule Sequencing. At the meeting, Helicos presented data on our collaboration with City of Hope, an NCI-designated Comprehensive Cancer Center, investigating genetic variation in the p53 gene and identifying a variety of mutations in the gene.

Meetings like these are what fuel my passion of improving human health through our growing knowledge of the genome, and I welcome those of you who attended with me to share your key takeaways.

Today is Public Health Thank You Day, honoring legislators, researchers, government agency employees, and other professionals who focus on community-wide health. Take a look at profiles of public health heroes, and spread the word!

Health Care for America Now is out with a new advertisement Tuesday morning that makes clear that Obama will be held to the health care reform promises he made while on the campaign trail.

The spot, airing in Washington D.C., uses an October speech by Obama on health care as a way to set the ground rules for his forthcoming administration.

Here is the new Health Care for America Now ad:

Speaking of health care reform, in a major development this week, America’s Health Insurance Plans and Blue Cross Blue Shield Association each announced that they would support a reform plan that requires insurers to provide coverage for anyone who applies, regardless of health status, as long as the plan also requires everyone to have health insurance.

On The Plank, Jonathan Cohn commented on the significance of this news for the health care reform movement:

If anything, this announcement is the latest sign that health care reform has serious political momentum heading into 2009. The insurance industry wouldn’t be taking this position if its representatives didn’t believe that the odds of universal health care passing are pretty good — and that they are better off trying to shape the plan from the inside than fight it, unsuccessfully, from the outside.
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Of course, they could change their minds… Still, every day that the insurance industry is saying charitable things about reform is a day it’s not using its resources to knock it down. And that has to help the overall effort.

At his Health Care Policy and Marketplace Review blog, Robert Laszewski expressed a less optimistic reaction to the news:

The industry’s proposal glosses over the real issue — figuring out how to make health insurance affordable so that a mandate that everyone buy coverage is practical and enforceable.
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To enforce an individual mandate to buy health insurance any successful reform program would likely have to cover the 75% of premiums most employer-programs cover in order to make insurance reasonably affordable for most of the middle-class.

So, the health insurance industry is saying that if we cover everyone — and therefore eliminate their underwriting risk — they’d be happy to take 45 million new customers at retail. How magnanimous!

On his The American Prospect blog, Ezra Klein offered his take on this news:

In return for a mandate in which every American must purchase health care coverage, they will sto